In the 24 hours since the letter was made public, most of the 20 chief executives named as co-signatories have distanced themselves from the message. In the letter Sir David urged the government to do “all it deemed necessary” to bring an end to the junior doctors’ contract dispute.

On Wednesday, as thousands of junior doctors were on strike, an email was sent to chief executives from Sir David’s office at 11.39am asking chief executives to sign up to a statement of support for the offer. It said the “request is urgent and he intends to make the inclusion unless you indicate otherwise by 3pm this afternoon”.

HSJ understands the chief executives had not seen Sir David’s full letter and were unaware their support for the final offer to the BMA would be linked to his call for the government to take action. Sir David advised the government to do “whatever it deems necessary” to “end uncertainty for the service”.

One chief executive said Sir David had “gone a step beyond what we had agreed to”.

The letter was published after 9am on Thursday and within hours Claire Murdoch, chief executive of Central and North West London Foundation Trust, publicly said she did not support contract imposition and wanted her name removed. Her name was taken off the published list.

A second chief executive, Andrew Foster at Wrighton, Wigan and Leigh FT, also said he did not support imposition. He told HSJ today: “What David produced at the very start of this week seemed like a very sensible compromise agreement on Saturday working. We were therefore asked to sign up to a statement supporting that. I think that is fair and reasonable.

Both sides in the junior doctors’ contract dispute have been urged to reach a negotiated settlement “before long term damage is done” to the NHS, by leaders from 21 medical royal colleges and associations.

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